STDs May Change Stance on Circumcision

March 26, 2009

By LAUREN COXABC News Medical Unit

Large study out saying that it reduces a host of STDS – and now doctors are renewing the debate large study out saying that it reduces a host of STDS – and now doctors are renewing the debate about whether parents should circumcise for health reasons.

ABC News Photo Illustration

Some doctors are calling for a slight change in America's thinking about circumcision after the latest -- and largest -- study in a series of investigations in Africa showed that circumcision may significantly reduce the risk of contracting herpes and HPV.

Doctors followed 5,534 men in the rural Rakai region of Uganda, periodically surveying their sexual risk-taking behavior. Half the participants were immediately circumcised, while the other half remained uncircumcised until the end of the study.

Over two years, the men who were circumcised had a 28 percent reduced risk of infection with the herpes virus and a 35 percent reduction in HPV infection. An author of the study called it a "double whammy" of an effect for women's health, too.

"Men are at risk for genital warts and things like discharge. Women are at risk for cancer," said Dr. Anthony S. Fauci, a co-author of the study appearing in the New England Journal of Medicine and the director of the National Institute of Allergy and Infectious Diseases.

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"The idea that you can prevent HPV in the male, then you would almost certainly, although not formally proven, prevent the male from infecting an uninfected female," he said.

In an accompanying editorial, authors of the study beg the question of whether Medicaid should uniformly cover circumcision across the country. As of now, Medicaid in 16 states does not cover circumcision, and more private insurance companies are following suit.

"Data like this may then sway the opinion of leaders," said Fauci. "It may actually have an impact on certain policy decision in the United States."

What Doctors Recommend for Circumcision

By the looks of it, Fauci may be right.

When people, especially doctors, make a decision about a procedure, they often look to official guidelines from professional medical academies.

The last new set of circumcision guidelines outlining the risks and benefits of circumcision came out of the American Academy of Pediatrics in 1999. The same guidelines were upheld in 2005. In sum, the guidelines were quite neutral about the controversial topic.

"Basically, it's considered a non-essential medical procedure," said Dr. Susan Blank, chairwoman of the American Academy of Pediatrics Task Force on Neonatal [male] Circumcision. "It does have health benefits, but it is not essential."

But guidelines do change. Blank said the academy noticed some "really very compelling data" that should be included on the next guidelines.

"It began with three very compelling studies that came out of Africa," she said. "The academy felt it was time to look at the full body of literature and see and what was out there."

Yet, as mounting evidence points to circumcision's health boons, new social movements and circumcision numbers show Americans are slowly abandoning the practice.

In 1979, the rate of circumcision nationally ranged around 65 percent. More recently, that rate had dropped, especially in some regions and among some ethnic groups, according to data from the National Hospital Discharge Survey.

By 1999, the most recent year of data available, only 36 percent of babies born in the West were circumcised.

Certainly, some of the change has been a social movement brought forth by groups, such as Mothers Against Circumcision and Intact.